Objective:To assess the effectiveness of a model created using clinical features and preoperative chest CT imaging features in predicting the chronic obstructive pulmonary disease (COPD) among patients diagnosed with lung cancer.Methods:A retrospective analysis was conducted on clinical (age, gender, smoking history, smoking index, etc.) and imaging (lesion size, location, density, lobulation sign, etc.) data from 444 lung cancer patients confirmed by pathology at the Second Affiliated Hospital of Naval Medical University between June 2014 and March 2021. These patients were randomly divided into a training set (310 patients) and an internal test set (134 patients) using a 7∶3 ratio through the random function in Python. Based on the results of pulmonary function tests, the patients were further categorized into two groups: lung cancer combined with COPD and lung cancer non-COPD. Initially, univariate analysis was performed to identify statistically significant differences in clinical characteristics between the two groups. The variables showing significance were then included in the logistic regression analysis to determine the independent factors predicting lung cancer combined with COPD, thereby constructing the clinical model. The image features underwent a filtering process using the minimum absolute value convergence and selection operator. The reliability of these features was assessed through leave-P groups-out cross-validation repeated five times. Subsequently, a radiological model was developed. Finally, a combined model was established by combining the radiological signature with the clinical features. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) curves were plotted to evaluate the predictive capability and clinical applicability of the model. The area under the curve (AUC) for each model in predicting lung cancer combined with COPD was compared using the DeLong test.Results:In the training set, there were 182 cases in the lung cancer combined with COPD group and 128 cases in the lung cancer non-COPD group. The combined model demonstrated an AUC of 0.89 for predicting lung cancer combined with COPD, while the clinical model achieved an AUC of 0.82 and the radiological model had an AUC of 0.85. In the test set, there were 78 cases in the lung cancer combined with COPD group and 56 cases in the lung cancer non-COPD group. The combined model yielded an AUC of 0.85 for predicting lung cancer combined with COPD, compared to 0.77 for the clinical model and 0.83 for the radiological model. The difference in AUC between the radiological model and the clinical model was not statistically significant ( Z=1.40, P=0.163). However, there were statistically significant differences in the AUC values between the combined model and the clinical model ( Z=-4.01, P=0.010), as well as between the combined model and the radiological model ( Z=-2.57, P<0.001). DCA showed the maximum net benifit of the combined model. Conclusion:The developed synthetic diagnostic combined model, incorporating both radiological signature and clinical features, demonstrates the ability to predict COPD in patients with lung cancer.

Objective:To investigate the clinical effect of free fibular flap of great toe without vein in repairing soft tissue defect of finger pulp.Methods:From June 2020 to January 2021, 8 cases of finger pulp soft tissue defect were repaired with free flap of fibular side of great toe without vein, including 6 males and 2 females, with an average age of 32(18-42) years old. The defect area of finger pulp was 1.0 cm×0.5 cm-1.8 cm×0.8 cm. The proper digital artery and digital nerve of the affected finger were anastomosed. All flaps did not carry reflux veins. The donor site of the toe was directly sutured. Postoperative routine anti infection, anti spasm and anticoagulant treatment was performed. Postoperative outpatient regular follow-up.Results:All flaps survived without vascular crisis, and the donor and recipient sites healed in the first stage. All patients were followed-up for an average of 6.4(4-12) months. At the last follow-up, the TPD was 6-8 mm, the hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Hand Surgery Society of Chinese Medical Association. Seven cases were excellent and 1 case was good.Conclusion:The free fibular flap of the great toe can be used to repair the small wound of finger pulp without carrying the draining vein, the flap can still survive. And it can provide a certain reference for the failure of anatomic separation of the draining vein.

The epidemic spectrum of acetabular fractures is changing with the changing population structure in China which has resulted in an increased proportion of the elderly patients. As acetabular fractures are intra-articular in nature, their management should follow the principles for intra-articular ones. However, it is still a great challenge for orthopedists to choose an appropriate treatment to deal with the fracture because of the pathophysiological changes in the elderly patients and the particular characteristics of acetabular fractures. Technical advances may offer a diversity of treatment options for geriatric acetabular fractures and demands for individualized management are increasing. In order to deepen the knowledge of geriatric acetabular fractures for orthopedists, this review expounds on the current achievements in the management and research concerning the fractures.

Objective To summarize the complications and their incidences following Anterior Subcutaneous Internal Pelvic Fixation(ASIPF).Methods A comprehensive search was conducted of PubMed Library,Cochrane Library,Web of Science,SinoMed,Wanfang Data and China National Knowledge Internet for all articles addressing the postoperative complications of ASIPF published in English and Chinese from January 2009 to November 2018.A proportion Meta-analysis across the studies was performed for the complications after ASIPF (lateral femoral cutaneous nerve irritation,femoral nerve palsy,heterotopic ossification,infection and implant failure) using R software.Results This meta-analysis included 29 clinical studies involving a total of 825 patients.The complications following ASIPF were lateral femoral cutaneous nerve irritation,femoral nerve palsy,heterotopic ossification,infection and implant failure;their incidences were respectively 12％ (95％ CI:from 7％ to 19％),3％ (95％ CI:from 2％ to 4％),30％ (95％ CI:from 22％ to 39％),4％ (95％ CI:from 3％ to 6％) and 4％ (95％ CI:from 3％ to 6％).Conclusions Lateral femoral cutaneous nerve irritation and heterotopic ossification are common complications following minimally invasive internal fixation for anterior pelvic ring injury.High-quality clinical research is needed into the factors leading to the complications and into their preventive countermeasures.

Objective:To explore the effect of the virulence factor OatA during Staphylococcus aureus infection.Methods: In vitro,wild type of Staphylococcus aureus USA300,OatA gene deletion strain or OatA gene complemented strain were used to infect mice bone marrow divided macrophages (BMDMs).Subsequently BMDMs were separated and the case of cell death were detected.In vivo,mice pulmonary infection model was constructed with nasal inhalation of Staphylococcus aureus.Alveolar macrophages were isolated and the case of cell death were detected.Results: In contrast to wild type and OatA gene complemented strain,OatA gene deletion strain induced severer macrophage death both in vitro and in vivo.Conclusion: The virulence factor OatA inhibits Staphylococcus aureus infection-induced macrophage death.

Objective To evaluate the effects of penehyclidine hydrochloride combined with ulinastatin on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-eight patients of both sexes,aged 20-64 yr,weighing 40-66 kg,of ASA physical status Ⅱ (NYHA Ⅱ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into 4 groups (n =12 each) using a random number table:control group (group C),penehyclidine hydrochloride group (group P),ulinastatin group (group U),and penehyclidine hydrochloride and ulinastatin group (group PU).Penehyclidine hydrochloride 0.02 mg/kg was injected via the right internal jugular vein at 15 min before induction of anesthesia in group P.In group U,the total amount of ulinastatin was 2× 104 U/kg,30％ of the total amount was given via the right internal jugular vein after induction and before surgery,40％ was added to the priming solution,and the remaining 30％ was injected via the right internal jugular vein while the aorta was opened.In group PU,penehyclidine hydrochloride or ulinastatin was given according to the method previously described in group P or U.The equal volume of normal saline was given instead in group C.After induction and before surgery (T1),at 30 min of CPB (T2),and at 30 min and 6 h after termination of CPB (T3,4),blood samples were taken from the left internal jugular bulb and radial artery for blood gas analysis and determination of jugular venous oxygen saturation,jugular venous O2 content,arterial O2 content,and plasma concentrations of S-100β protein and neuron-specific enolase (NSE) (by ELISA).Arteriovenous oxygen content difference (Ca-jrO2) and cerebral O2 extraction rate (CERO2) were calculated.Results Compared with group C,SjvO2 was significantly increased,and CERO2 was decreased at T2.3 in P and U groups and at T2.4 in group PU,and Ca-jvO2 and plasma concentrations of S-100β protein and NSE were decreased at T2,3 in P,U and PU groups.The plasma concentrations of S-100β protein and NSE were significantly lower at T2,3 in group PU than in P and U groups.Conclusion The combination of penehyclidine hydrochloride and ulinastatin produces better efficacy than either alone in attenuating brain injury in patients undergoing cardiac valve replacement with CPB.

Objective To compare the thin-section CT findings of pulmonary candidiasis,aspergillosis and eryptococcosis wim histopathology in immunoeomprimised rabbits and impmve the diagnostic accuracy of fungus infection. Methods Heathy New Zealand white rabbits were used for immunoeompromised animal models.Thin-section CT scan was performed before and 2,4,6,8,10,12,14 d after inoculation.The pattern and distribution of the pulmonary abnormalities were retrospectively assessed by two thomeic radiologists and compared with histopathology.The granulocyte count was compared before and after administration of immunosuppressive agents.The pmred t test,chi square test and the Fisher's exact test were used for the statistics.Results Fourteen rabbits had candidiasis.16 rabbits had cryptocoecosis,15 rabbits had aspergillosis.The granulocyte counts before and after administration of immunosuppressive agents were(2.91±0.92)and(0.35±0.19)×109/L respectively in eandidiasis group,there was a significant difference(t=12.484,P＜0.05);(2.51±0.82)and(0.76±0.71)×109/L in aspergillosis group,there was a significant difference(t=5.792,P＜0.05);(2.10±0.65)and (0.48±0.22)×109/L in cryptococcosis group,there was a significant difference(t=8.199,P＜0.05).The onaet time of infections on CT were not significantly different in three groups (P＞0.05).Ground glass opacity (GGO) and consolidation were the two most colnlnon findings in immunocompromised rabbits with three fungus infections,areas of GGO was correlated with the congestion,hemorrhage,inflammatory cell infiltration and interstitial hyperplasia in pathology. Consolidation was correlated with the severe congestion,hemorrhage, inflammatory cell infiltration, interstitial hyperplasia, necrosis and vascular embolism in pathology. Conclusion GGO and consolidation are the two most common findings of fungus infections in immunocompromised animal models and thin-section CT findings can reflect the pathological changes.

Objective To review the CT findings in patients with pulmonary infection after kidney transplantation and to determine the characteristic features in different infections.Methods The medical records were reviewed in 446 patients with pulmonary infection after kidney transplantation and 121 patients who had pulmonary thin-section CT were included in this study.The pattern and distribution of the pulmonary abnormalities were interpreted independently by two thoracic radiologists.Statistical analysis was performed using the X2 test and the Fisher's exact teat.Results (1)Time course:65(14.6/) patients initially had pulmonary infection in the first 30 days,147(32.9/)between 1 and 3 months,91(20.4/)between 3 and 6 months,23(5.2/)between 6 and 12 months,120(26.9/)afler 12 months of transplantation.In the first month after procedure,bacterial infection(4/5,80.0/)was the most common infection,bacterial(34/41,82.9/)、mixed(19/41,46.3/)and virus infections(11/41.26.8/)were seen commonly 1 to 6 months following transplant,the incidence of fungal(14/38,36.8/)and myeobaeterial(5/38,1 3.2/)infections was increased after 1 2 months of transplantation.(2)Pathogens:Baeterial(34,28/)and mixed infections(34,28/)were the most common,followed by fungus infeetion(9.7/),TB(7,6/)and eytomegalovirus(5,4/).(3)CT findings:Ground-galss attenuations(69,57.0/)was the most common findings of pneumonia,followed by reticular or linear opacities(68,56.2/),nodules (66,54.5/),pleural thickening(41,33.9/),consolidations(31,25.6/),tree-in-bud patterns(24,19.8/),pleural effusion(22,18.2/),and bronchovascular bundle thickening(16,13.2/).Ground-glass attenuation was commonly seen in cytomegalovirus pneumonia (4,80.0/),and nodule was commonly observed in bacterial infection(23.67.6/),tree-in-bud pattern was the most common finding in pulmonary tuberculosis (4.P=0.049).There were no statistically significant difierences in the prevalence of other CT paRerns (P＞0.05).Conclusions The peak incidence of pulmonary infection is in the 3 month after renal transplantation and bacterial infection is the most common.The CT diagnosis of infeetion can be made by combining the time course of infection,clinical laboratory data and lesion distribution.

Objective To explore effects of heroin and ephedrine on the histological structure and ChAT activity of hypothalamus and hippocampus of filial mice. Expression of Bcl-2 associated X protein(Bax protein) and keratinocyte growth factor(KGF) of hypothalamus and hippocampus were measured. Methods One hundred and eight filial mice were given intraperitoneal injection of heroin and ephedrine by gradually increase of doses, apoptosis and expression of Bax protein and KGF of hypothalamus and hippocampus were observed by Giemsa staining and immunohistochemistry, and the ChAT activity was detected by colorimetry. Results After administration of heroin and ephedrine at 5,10,15,20 days, the number of apoptotic cells and expression of Bax protein and KGF of hypothalamus and hippocampus were significantly increased and ChAT activity was lower than those of the control group(P<0.05 or P<0.01). There were differences between heroin group and the ephedrine group in the above-mentioned four indexes (P<0.05 or P<0.01). The number of apoptotic cells and Bax protein and KGF immunopositive neurons of hypothalamus and hippocampus increased by the increase in dose of heroin and ephedrine. Conclusions Heroin and ephedrine had great effect on the histological structure and ChAT activity of hypothalamus and hippocampus of filial mice, and this effects would be related to the cell apoptosis of hypothalamus and hippocampus.

Objective:To optimize the injection protocol of contrast medium for contrast-enhanced MRA (CEMRA) of pulmonary artery and to evaluate the diagnostic value of CEMRA and pulmonary perfusion imaging (PPI) in an experimental model of acute pulmonary embolism. Methods:CEMRA and PPI were performed in 6 normal pigs with different doses of gadolinium contrast agent (5ml, 10ml, 15ml, 20ml and 25ml) at an injection rate of 3ml/s, and 3 pulmonary embolism models were injected with 20 ml contrast agent at 3 ml/s. DSA was also performed for comparison. Results:The signal intensities and the signal to noise ratios of the pulmonary arteries kept increasing with the dose increase of the contrast agent, but the best angio-pulmonary contrast dose was 10-15ml (0.25-0.375mmol/kg), while the optimal dose for PPI was 15-20ml (0.375-0.5mmol/kg). Although CEMRA demonstrated less obstructed pulmonary arteries than DSA (5/10 vs 8/10)did, it detected all obstructions when combined with PPI. The pulmonary infarction zones showed wedge-shaped perfusion defects on the PPI images, with the signal intensities lower than those of the normal areas (137.86±45.32 vs 330.14±46.52, P<0.001). Conclusion:It is suggested that the optimal dose of the contrast agent is 0.25mmol/kg to 0.375mmol/kg for CEMRA, and 0.375mmol/kg to 0.5mmol/kg for lung perfusion. CEMRA combined with PPI may be better than DSA in demonstrating pulmonary embolism.